On June 3, the Vancouver Police Department issued a rare public warning calling attention to seven suspected heroin overdoses that occurred in the Downtown Eastside that day.

Over coffee the following morning, Darwin Fisher told the Straight that five of those incidents occurred in just three hours at Insite, North America’s only sanctioned supervised injection facility, where he’s a program manager.

He also emphasized that Insite has operated at capacity for years, which means many users are injecting outside the health-care system, where the risk of an overdose turning fatal is much higher.

Fisher reported that evening wait times at Insite usually range between five and 15 minutes. “What’s impressive is they’re sitting in that lineup, sometimes going through those feelings of withdrawal that are really brutal,” he said. “They’re doing that because they desperately want to use where somebody’s got their back.”

Vancouver is long overdue for a second facility like Insite, Fisher maintained.

Patricia Daly, chief medical health officer at Vancouver Coastal Health, told the Straight the same thing. “We know that we need to expand supervised injection as a nursing service,” she said in a telephone interview.

According to Daly, the jump in overdoses noticed by the VPD actually began during the last week of May, when health authorities recorded about twice the normal number of incidents. That week there were nine overdoses at Insite plus at least 24 in Vancouver emergency rooms, she said. (None were fatal.)

"We’ve seen that heroin overdoses have been high for about two years, compared to historical numbers," she added. "So we have occasional spikes like this periodically."

A cost-effective strategy

More than 10 years after Insite opened in 2003, Daly revealed that there is a plan in the works to increase access to supervised injection in Vancouver.

She said VCH is waiting on a federal application filed for the Dr. Peter Centre. The West End clinic integrated supervised injection into the range of services it offers in 2002 but only applied on January 28, 2014, for a Health Canada exemption required to make those activities legal.

According to Daly, it’s the differences between Insite and the Dr. Peter Centre that make the latter an appealing model to follow.

Instead of hosting supervised injection services at a stand-alone facility with significant startup costs and high administration fees, the Dr. Peter Centre, at Comox and Thurlow streets, was built to include a small injection room. There, nurses already providing a range of health services simply offer one more.

“That’s very inexpensive,” Daly said. “That’s the kind of model that we’d like in order to be able to expand this service.”

She noted there’s a precedent for that kind of development. Daly suggested supervised injection could grow in Vancouver like needle exchange did in the late 1990s and early 2000s.

“We would like to be able to incorporate supervised injection into those sites where we have nurses who can do supervision and where it makes sense,” she said. “It would have to happen gradually.”

Complaints over delays

The Vancouver Area Network of Drug Users (VANDU) is critical of delays. Its executive director, Ann Livingston, has helped operate a number of unsanctioned supervised injection sites, the most recent of which ran for about four years before VCH shut it down in January 2014.

“There’s a sense that things are going backward,” Livingston told the Straight. “People were coming there because they needed help.”

She said she supports VCH’s plan to integrate supervised injection into existing clinics, but argued that in the meantime, the need for unsanctioned facilities is too great to ignore.

Donald MacPherson was the City of Vancouver’s first drug policy coordinator and the author of its “four pillars" strategy on addiction. In a telephone interview, he also questioned why regional health authorities seem to be dragging their feet on a plan with such wide support.

“We have not scaled up this intervention appropriately given the demand,” said MacPherson, who’s now director of the Canadian Drug Policy Coalition and an adjunct professor at SFU. “We took our foot off the gas.”

He added that while he agrees the Dr. Peter Centre model is a cost-effective one, stand-alone sites will likely still be required in some areas; east of Main Street around Oppenheimer Park, for example.

“You need to look at where most high-risk injectors are living and consuming their drugs and you need to figure out a way to meet the demand there,” he said.

Daly said she sympathizes with those concerns and has met with VANDU board members several times in recent months. But she emphasized that VCH needs to keep Insite in good standing, legitimize the Dr. Peter Centre, and then work on expanding access to supervised injection by creating additional sites.

“We want to do it by best practice and in a way it doesn’t jeopardize those legal exemptions,” Daly said.